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that many of those who were Dr. Quain's colleagues when the work was commenced did not live to see the conclusion of his labours, their places being taken by other men. In this way we may account for the absence of Murchison's signature under the various articles on the continued Fevers and on diseases of the Liver, to which we referred in the hope that we might still find something from his valued pen. The only article by him that we have seen is that on Jaundice, and it is such as to cause regret that he did not live to contribute more largely to the pages before us.

With such a numerous band of writers, it is only to be expected that there should be various degrees of excellence, literary and otherwise. But it may be said in general that the method adopted, and the careful editorial supervision, have combined to produce a tersely and clearly written work, which will take a valued place in the practitioner's library. It is somewhat difficult at times to see the principle on which space has been allotted for the various articles; thus, Gout gets 15 pages, while Kidney Diseases, including the articles on Bright's Disease and Albuminuria, are dismissed in 20. When under the heading Typhus we find no description of the course of the temperatures, and an unqualified statement to the effect that "the amount of rash is of little moment, and is no guide to the severity of the attack," we are inclined to wish that a little more space had been allowed, so as to admit of a fuller description, and of less dogmatic statement of opinions contrary to those held by men of the largest experience in fevers. Many of the articles are simply brief definitions, usually with references to general articles where the subjects are discussed in detail. But among these we look in vain for Crossed Paralysis, Alternate Paralysis, Anthracosis, Decubitus (in the sense of Acute Bedsore), Parovarian Cyst, &c.

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A special feature of the work is the giving of the derivations of words, and this part seems to us to have been hastily done and imperfectly revised. For instance, we find the following: "Lymph (vúuon, a nymph, water);" "Lymphangeitis (vouon, water or lymph, and ayyɛtov, a vessel); Lymphangiectasis (lympha, lymph, and angiectasis, vascular dilatation); Adenoma (adv, a gland, and óuós, like);" "Erysipelas (pów, I draw, and weλas, near)." It is impossible to account for such a mistake as víupn, but angiectasis may be supposed to refer to an article given in the dictionary as angiectasia. In the case of adenoma, an attempt has been made to account for the termination, but in deriving sarcoma, carcinoma, and other similar words, this attempt has wisely been abandoned, as it

fails to account for the fact that Greek words with that termination end in wua. All that can be said about it is, that the termination has been adopted to signify a tumour. With regard to erysipelas, a reference to Liddell & Scott would have shown the writer that there occurs in early Greek medical writings the word ipvoímeλas, which is derived from the root of ερυθρός, red, and πέλλα, the skin.

We know that the publication of such a work must have involved enormous labour, and details, when comparatively unimportant, are apt to receive but slight attention. It is but right, however, that in succeeding editions such mistakes should be remedied; and from its nature, the work is one whose value can be maintained only by frequent revision and extension. Frequent editions will undoubtedly be called for, as the volume in large measure comes up to the expectations that had been formed of it, and will no doubt commend itself to students, but especially to practitioners, as meeting a want in the shape of a ready work of reference of moderate dimensions, and up to date.

The Relative Mortality after Amputations of Large and Small Hospitals. By HENRY C. BURDETT. London: J. & A. Churchill. 1882.

THIS is a reprint of a paper read by Mr. Burdett before the Statistical Society, and is the result of inquiries which he sent to 160 cottage hospitals. Answers were received from ninety-two, into thirty-one of which no cases requiring amputation had been received. The amputations under review were performed in sixty-one hospitals, from their institution until the end of the year 1878, a period of twenty years. The total number is 326, the deaths 58, and the mortality 17 per cent. To prevent his statistics being impugned, as Sir James Simpson's were, Mr. Burdett gives details of the cases, and has only collected actual figures, which could be definitely verified from the books kept by the medical staff of the different hospitals. He also gives the causes of death so far as could be ascertained, and these include pyæmia and tetanus, formerly the scourges of our great hospitals. For purposes of comparison, Mr. Burdett is content to take the statistics of Sir James Simpson, published so long ago as in 1869, and those of Mr. Erichsen in 1874, of the large Metropolitan and Provincial Hospitals; but we submit that he ought also, in fairness, to have brought

down the statistics of these to the end of 1878, as, owing to the introduction of antiseptics and other causes, the mortality in them has been considerably reduced. To give an example: the mortality after amputation in the Glasgow Royal Infirmary, as given by Sir James Simpson in 1869, was 39.1 per cent; but in this Journal, in the year 1877, Dr. Thomas, the superintendent, showed that the mortality to the end of 1873 had been reduced to 32 per cent, and still later, in the Lancet of last year he gave the mortality for the previous eight years as 22.8 per cent, or a decrease of nearly 42 per cent in the space of twelve years. This is a remarkable decrease, and we have no doubt a similar result has been obtained in other hospitals. The mortality in the large German hospitals used to be very great, but the rate given by Dr. Schede, of Hamburg, of cases treated in them antiseptically, is only 2.9 per cent. This is a result which we fear will never be attained here, owing to the severity of the injuries admitted into our hospitals; but, still, we have seen that progress has been made, which we trust will be continued. Mr. Burdett is eloquent in his praise of the antiseptic system, and indicates that a peerage should be given to Mr. Lister and Spencer Wells for what they have done towards the saving of life. We quite agree that honours should be bestowed on these and others, as they are very sparingly dealt out to eminent members of our profession.

He likewise admits that Listerism has solved the question of large and small hospitals, and declares that their size and condition are of comparative unimportance, so long as they are kept antiseptic. With this we quite agree, but at the same time are of opinion that cottage hospitals should be introduced into some of the populous places in the neighbourhood of Glasgow, from which many severe cases of accidents are taken to our infirmaries, as the nearer the hospital is the better for the patient.

The discussion which followed the reading of the paper at the Statistical Society is also given. We were amused at the remarks of one speaker, who gravely told his hearers that "the mortality in the Glasgow hospital in which Mr. Lister himself practised, was so great that the building had to be pulled down and a new one erected." Not one of those present

corrected him; and we only trust that Mr. Moore and the other members of the Society are better posted up in statistics than they are about the Glasgow hospital. With this exception we commend the book to the notice of our readers as one from which much valuable statistical information may be gleaned.

No. 4.

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Since writing the above, we have received the annual report of the Glasgow Royal Infirmary for the year 1882. The number of amputations performed was 93, the deaths 15, and the mortality 16.1 per cent. Deducting ten amputations of the hand, ankle (Pirogoff), foot, and a re-amputation of the leg, the number is 83, with 14 deaths, or 16.8 per cent; whilst for the four major amputations only, it is 163 per cent: results better than those shown in the Cottage Hospital statistics.

The Essentials of Bandaging, with Directions for Managing Fractures and Dislocations; for Administering Ether and Chloroform, and for Using other Surgical Apparatus; and containing a chapter on Surgical Landmarks. Illustrated. By BERKELEY HILL, M.B. Lond., F.R.C.S. Fifth edition. London: Smith, Elder & Co. 1883.

THE issue of a fifth edition of such a work is the best proof of its value and fitness for the purpose it professes to serve, and it is particularly and unusually gratifying to find that the improvements, or at least additions, inevitable in new editions have not in this case materially increased the bulk of the volume. Too often do we find, especially in books of this character, handbooks to a special section of professional work, that the first useful and condensed manual is, in its later editions, expanded into a more or less systematic treatise, and so ceases to serve its primary purpose, yet does not advantageously take the place of works originally more pretentious.

Viewed as a whole, the book is worthy of the highest commendation; some parts of it, indeed, are, as far as we know, unique in their utility. Nowhere in such a terse, clear, and practical way are the "surface guides and landmarks" laid down, and for the more advanced surgeon this will probably form the most useful chapter, enabling him at a moment's notice to refresh his memory as to the exact guides for any procedure a piece of surgical knowledge which we have always found one of the most difficult to retain in the mind with accuracy.

There are a few faults, chiefly of omission, to be detected, most of them arising from the purely metropolitan methods recommended. Especially do we remark the absence of many arrangements and appliances familiarly used in all Scotch hospitals. Indeed, what is given as the Scotch long splint is perhaps the most unsatisfactory description in the book. We venture to say that a long splint put on exactly as directed

could not be found in any Scotch hospital to-day. The section on the administration of anaesthetics seems to us decidedly meagre, and to some extent misleading. The bald statement that "the pulse gives the earliest indication of syncope, it should therefore be constantly under the finger," is directly contrary to the teaching of some distinguished surgeons; and the extreme importance of very forcible drawing forward of the tongue when any respiratory failure occurs-not to remove the tongue from the glottis, but by traction on the parts at its root, to excite by reflex action respiratory movements-is not made sufficiently clear. Again, the different effects of ether and chloroform in the abolition of eye reflex is not noted. The avoidance of stimulant before the administration of chloroform is enforced, although it is directly contrary to the physiological indications and to the practice of a very large number of surgeons. The whole section on anæsthetics might, in the next edition, which will doubtless very soon be required, be with advantage made more complete, and if space for this is needed, it might be obtained by the omission of the paragraphs upon the laryngoscope and ophthalmoscope, instruments the use of which cannot possibly be learned from any book, and which are of far too great importance to be explained to advantage in the few lines devoted to thern here.

Amongst minor details we fail to find any mention of Martin's bandages, or of the dilating bags for plugging the nares which, when obtainable, must supersede all other appliances for this purpose. While making the above remarks rather as suggestions than as criticisms, we feel that their fewness in number and small importance show how great is the value and how excellent the method and manner of execution of the work. We feel sure that this edition will prove as acceptable and useful to its readers as the previous editions have long been.

Annual Report of the Board of Regents of the Smithsonian Institution, showing the Operations, Expenditures, and Condition of the Institution for the Year 1878. Washington: Government Printing Office. 1879.

The same for 1879 and 1880.

IN our issue for February, 1880, we directed the attention of our readers to the Smithsonian Report for 1877, and took occasion to explain the origin and nature of the Smithsonian Institution. We have now before us the three succeeding volumes of these Reports, and again make them the subject of

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